Obesity should be managed before pregnancy for best outcomes

15 August 2016

Being overweight poses increased risks during pregancy

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Half of mothers are overweight or obese at the start of pregnancy

More than 50 per cent of women are now overweight or obese at the start of a pregnancy, however pregnancy may not be the best time to address the issue, explains University of Sydney researchers in a perspective piece in today’s Medical Journal of Australia.

Obesity during pregnancy can have adverse consequences for the mother including gestational diabetes, hypertension, pre-eclampsia, increased likelihood of a caesarean delivery, and an elevated risk of cardiovascular disease in future years - all of which are potentially avoidable.

According to authors Associate Professor Kirsten Black and Dr Adrienne Gordon from the University of Sydney and Charles Perkins Centre, pregnancy may be considered an opportune time for medical practitioners to engage women in discussions about the effects of obesity, but it is usually “too little too late” for any meaningful benefit.

“While pregnancy may be a good time to intervene as women are often more motivated to change their behaviour during this period, it may not be the ideal time for trying to reduce the effects of obesity,” said the authors.

“Evidence is growing that obesity should be tackled before pregnancy if interventions are to have any effect, but capturing those women who need to lose weight before conception is complicated by the fact that one-third of pregnancies that proceed to antenatal care are unplanned.

“Another significant problem is the lack of evidence on which to base recommendations about weight loss and lifestyle changes before pregnancy for improving maternal and neonatal outcomes. Randomised trials concerned with pre-pregnancy weight have so far focused on obesity and reduced fertility.”

The authors recommended an approach might be to educate women about the effects of obesity during their pregnancy and the post-birth period, and to advise them of programs for reducing post-birth weight retention and therefore of obesity during later pregnancies.

“Women should be aware of the increased risks that obesity poses during and after their pregnancy and be supported to make and maintain diet and lifestyle changes to improve their health," said the authors.

“This approach will require hospitals and health services to take a more long term perspective of pregnancy and the post-birth period, as well as government investment in these public health strategies."